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Manuelle Medizin 30.96 -98 (also, Journal of Orthopaedic Medicine Vol.23  No2  2001)

Female infertility: a Study of Physical Treatment by the method of L. Mojzisovà for functional disturbances of the Pelvic Region.

H.Volejníková Brno, CSFR (Rehabilitation Department of the BRNO University Maternity Hospital).

Summary:

Of 166 women suffering from some type of functional sterility 118 were followed up. They were divided into 5 groups. Group A and (later) group E were treated and trained according to the method of Mojzisovả. The method consists of mobilisation techniques, post-isometric relaxation, and soft tissue techniques. Treatment lasted for 6 months. The number of women successfully treated was significantly higher in those who were treated by the method of Mojzisovả as compared to the controls.

Keywords:

Female sterility - Functional disturbances of lumbar spine and pelvic ring - Mobilisation techniques - Post-isometric relaxation.

The success rate of the method of treatment of Mojzisovà for female sterility due to functional pelvic disturbance was tested at the rehabilitation unit of the University birth clinic of Brno.

The study period lasted from June 1987 to June 1989. Following a project by Dr. E. Frankovà Ph.D, the treatment was performed by a female Physiotherapist who has been trained by L Mojzisovà.

Material and Method

The study population consisted of a group of 166 women who had been referred for medical rehabilitation of sterility which was previously treated  unsuccessfully for an average of 4 years. Suitability for the study was a ssessed with the aid of aquestionnaire filled in by a gynaecologist. The following criteria were applied:

q       Age between 22 and 30 years

q       Normal quality and quantity of sperm of partner

q       Patency of fallopian tubes

The women were randomly allocated to groups A, B or C. Furthermore groups D and E were made up, details of which will be considered in a later section. Treatment was scheduled on a monthly basis for 10 women at a time from groups A, B and C. The same was repeated for the following months.

At the rehabilitation unit the women were:

q       informed about the effect of the methods of rehabilitation,

q       given further information regarding the treatment routine (temperature measurements, fluid intake, necessity to perform exercises twice daily, etc.);

q       examined by the female physiotherapist for: posture, pelvic distortion, leg length, pressure sensitivity of vertebrae and costosternal joints, rib fixations and muscle tightness, signs of hypertonicity of the pelvic floor musculature, etc.);

q       gynaecologically examined by Dr. J. Navratilovà.

The success of treatment (pregnancy) was determined as described below:

q       Number of women treated successfully in group A following the treatment and exercises of Mojzisovà.

q       Number of women treated successfully by a different therapeutic regime and different exercises (group B).

q       Number of untreated women in group C who also did not follow an exercise regimen.

Group A (n=50)

In this group women were treated by the method of Mojzisovà, which specifically included treatment of the lumbar spine and pelvis. Both areas have a close association with reproductive organs.

Method of treatment  1-4

1. Stretching and relaxation of lumbar and pelvic musculature, post-isometric relaxation (PIR) buttock and pelvic floor muscles as well as strengthening of muscles of the chest. Exercises were explained to the women on their initial visit and instructions were given to perform these at home twice daily for the following 4-6 weeks.

2. In the first half of the menstrual cycle the female physiotherapist also:

q       relaxed pelvic floor muscles: after initial warm-up PIR, internal rectal massage and coccygeal treatment were performed.

q       Following this, mobilisation of hypomobile areas in the sacroiliac joints, lumbar spine, and ribs was performed.

q       The home exercise program was checked and corrected. Furthermore additional exercise with the purpose of strengthening pelvic floor, buttock and abdominal muscles were prescribed.

During the course of the next menstrual cycle the last two points were repeated. Relaxation of pelvic floor musculature was only performed if clear indication of hypertonicity existed.

If, for whatever reason (illness, holidays), one of the women missed a treatment this appointment, was delayed to the next menstrual cycle.

The course of a treatment ended after 6 visits and was considered successful if a pregnancy occurred in this study period.

Group B (n=50)

For this group a different set of active and passive exercises was performed than that of group A (designated ‘non-genuine’ exercises in the following text). Care was taken so that these exercises did not affect the areas involved in Mojzisová’s method. The women were blinded to the fact that the exercises were non-effective.

This group also differed from group A with respect to the organisation of check-up examinations at the rehabilitation department. During the two year study period Mojzisovà’s method was already well known even among laymen. Due to technical difficulties it was impossible to completely separate the two groups in waiting rooms and corridors so that it was possible for the women to discover differences between prescribed exercises and treatments. Therefore monthly check-ups of group B were organised in small groups in advance. This allowed the creation of an isolated group. The goal of this group was to prevent information about treatment in group A to become known to other subjects.

These conditions lead to other unforseeable differences:

q       Missed appointments could not be re-scheduled and were missed completely

q       Due to monthly group meetings the women were able to develop relationships, talk about their experiences with the treatment and some women only attended to announce their pregnancy.

The above conditions put group B into an advantageous position as compared to women in the other groups who attended check-ups individually.

In accordance with group A the treatment of group B consisted of the following:

q       Active ‘non-genuine’ home exercises (4 weeks)

q       monthly group meetings not taking into account timing of menstrual cycle. Firstly home exercises were repeated and secondly ‘non-genuine’ passive exercises were performed individually.

These meetings took place six times and were deemed successful if pregnancy occurred in that period.

Group C (n=50)

This group did not exercise although the initial talk and gynaecological examination were the same as for the other groups. Date and time of the

next appointment were negotiated so that the women knew that treatment was merely delayed by six months.

The purpose of this group was to exclude the possibility of a psychological effect on the number of pregnancies due to expectation of treatment.

The observation period was also six months and positive outcomes were pregnancies which occurred between the initial examination and before commencement of treatment.

Group D (n=16)

Due to timing difficulties it was impossible to integrate this group into group B.

Treatment consisted of active home exercises which were not checked regularly by the medical rehabilitation unit. Also passive exercises (‘non-genuine’, group D) were not performed.

Although the treatment period was only three months results are of interest and will therefore be discussed. Pregnancy within three months of commencing exercises was designated as success.

Group E (n=76)

Women in this group were those who did not become pregnant after performing either ‘wrong’ exercises (groups B and D) and those who did not exercise at all (group C). Treatment lasted six months and followed Mojzisovà’s protocol (group A).

These women therefore were not disadvantaged but treatment and possible following pregnancy were merely delayed by six months. This is in agreement with medical ethics.

Again treatment was concluded after 6 check-ups and success was described as pregnancy during the treatment period.

Results

Results are shown in table 1. It can be clearly seen that the success rate was significantly higher in those women treated with Mrs. Mojzisovà’s method (groups A and E) as compared to who were not (groups B and D).

In the light of these results it would be interesting to compare effectiveness of this method with other reflex therapeutic protocols (mobilisation techniques, acupuncture, reflexology, massage).

Statistical analysis was performed by Dr. V. Novàk and RN Dr. H. Koukalovà.

Statistical results

The x²-test was used for statistical analysis taking into account the number of pregnancies in individual groups. Firstly an overview table will be shown (table 1).

In table 1 x² =13.543 which correlates with p<0.01. The number of pregnancies is therefore in statistically significant relation to treatment in individual groups. Since results of groups B, C and D are similar success rates of these three groups were established in the same way, yielding X²=0.012 which correlates with p>0.975 i.e. the groups are almost identical. For this reason these groups were summarised into one group, which was compared to groups A and E (table 2).

In table two x²=12.179 correlating with p<0.0005, and in table three x²=9.262 correlating with p<0.005.

There is a highly statistically significant relationship between pregnancies and treatment method insofar as groups A and E showed higher numbers of pregnancies than groups B, C, and D.

Comparison of groups A and E showed x²=0,503 (p>0,45). This signifies that treatment in these two groups did not differ statistically.

Discussion

A larger group of patients was treated by Mojzisová's method subsequently, giving further information about the typical symptoms and signs of this group of people with infertility. Typical symptoms other than infertility were: dysmenorrhea, menorrhagia with clots, dyspareunia, back pain, and headache. On examination, the following were frequent findings: bad posture with scoliosis, sacro-iliac dysfunction, asymmetrical intergluteal line, weakness of the caudal third of the gluteal muscles, with insufficient contraction of both the gluteal muscles and the Levator ani: reflex spasm and/or tenderness of the adductors, of the coccyx, of the sacroiliac joints, of the lumbar erector spinae, of the lower part of the abdominal wall between the umbilicus and the groin, all usually on the right, and between the umbilicus and the the anterior iliac spine, usually on the left.

The success rates for pregnancy in this larger uncontrolled group, according to age group, was:

¨      ages 20-24:    46.58%

¨      ages 25-29:    40.94%

¨      ages 30-34:    30.96%

¨      ages 35-39:    24.73%

¨      ages 40-44:    11.11%

Conclusion

Statistical analysis using the x²-test showed a statistically significant higher proportion of pregnancies in groups A and E, which were treated and exercised following Mojzisovà’s protocol as compared to (control) groups B, C and D. There was no significant difference between the number of pregnancies when comparing groups A and E.

Table 1 - Trial results

  Table 2 - Overview of statistical results A

Table 3 - Overview of statistical results E

The Publishers

P.S. Translation from the German text in MANUELLE MEDIZIN¹ Manuelle Medizin   30  96-98 (1992) by Timo Kaschel, Intern at the Anglo -European College of Chiropractic, Bournemouth, England for, and edited by, Michael Davidson DC FCC, Chiropractor, Gillets Farmhouse, Woodville, Stour Provost, Gillingham, Dorset, SP8 5LX, tel/fax. 01747-838553, e-mail msdchiro@aol.com

I am indebted to the Springer Group for permission to publish this English version of the article originally published in German. This was originally translated from Czech into German by Professor K Lewit.

The article has now been published in the Journal of Orthopaedic Medicine, Vol.23 No 2, 2001, pages 47-49. Some minor changes have been made by Professor Lewit, who has also added a valuable Discussion paragraph, which I have taken the liberty of including. On page 2 ,group A (N==50), I prefer the words "reproductive organs", rather than "sexual organs".

The original article in German is available from MSD or the publishers.  The original reference to this article was from the text "Manipulative therapy in Rehabilitation of the Locomotor System" Reed Educational and Professional Publishing Ltd, 1985, by neurologist Professor Karel Lewit, Senior Leader in the field of Eastern European Manual Medicine, Czech Republic.

  ¹ Published by the SPRINGER Publishing Group.

Contacts.

Prof.K.Lewit

252 29 Dobrichovice 360

Czech Republic

Dr Richard M Ellis FRCS FRCP

Editor in Chief, Journal of Orthopaedic Medicine

District Hospital

Salisbury ,Wiltshire SP2 8BJ

England.

e-mail  jom2@compuserve.com

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